How will Oregon pay for Medicaid expansion in 3 years?

Over the last two Sessions we did a lot of work in the creation of Coordinated Care Organizations (CCO). It is the intent of the Senate Health and Human Services Committee, of which I am the vice chair, to do nothing this year relative to their structure. Because it was our intention to allow these organizations the ability to develop locally, and because none of them are even a year old, it would be inappropriate for us to be doing so. Keep in mind I am just speaking for the Senate and would not assume to know what the House might be considering. The one area I have suggested we dig into are the metrics; not only those newly created by the Oregon Health Authority, but also those required by the federal government. Metrics are the data points and statistics required for different levels of accountability, and I want to make sure we are measuring the right things and not over complicating the system.

Another major issue will be the insurance exchange, which now goes by the name Cover Oregon. At this point it may be possible this issue will only be dealt with in the Ways and Means Committee, which I find unfortunate. I supported the concept two years ago, hoping we would basically be creating just a market place. One of the issues still to be resolved is whether the IT platform will actually work. But the more important issue is the development of the business plan. What I am hearing unofficially is the matrix currently on the table is going to significantly increase insurance rates. If the goal of this is to force everyone into a government program, this would go a long way towards accomplishing this, and there are many who have that as their objective. If at the end of the day the outcome of what is being proposed will do little more than create more government jobs and kill private sector insurance coverage we need to do everything we can to stop it.

Keep in mind as a member of the minority party we can’t stop anything without some help from the other side. For example, I am certain we are going to do the Medicaid expansion referenced in the federal act. We will do this with the promise from the feds that they will pay 100% of the cost from the first two years. My real issue, besides the expansion of an entitlement program our nation is having to borrow money to pay for, is the impact this will have on our state budget year three and beyond. We are currently able to keep our state Medicaid budget in place because of the “gift” of the additional federal dollars we are receiving above standard rates and this money as well will run out in time. Politically speaking it becomes very hard to take away an entitlement once it has been implemented. This would leave us three or four years from now with the potential choice of cutting funding to education or public safety, or looking at a massive tax increase. None of those choices are good, but I believe this is the scenario we will be setting up.

We have already had a couple of “Health Care for All” rallies here and some of my constituents have visited me on the issue. What everyone needs to understand is the fact health care will always be rationed, as it is in every system anywhere in the world. What we are doing at the very least is changing the decision point as to where the rationing happens. I would still like to find a way to have these issues dealt with at the patent/provider level, but we are not there. So far in health care transformation all we have done is rearrange the seats at the table for the Medicaid program. It is too early to tell if this experiment will work for the public sector let alone trying to expand it to the private sector.

I am already hearing stories about some businesses having to cut back on their employee’s health care coverage and we need to do everything we can to prevent this from happening. My personal take away from the President’s State of the Union address was that government was the answer to all of our problems. My fear is our Governor may be of the same mind. Time will tell how far down this road we end up going.